HIP HIP HOORAY; solutions for your hip pain
Have you been experiencing hip pain that keeps you up at night? Hip pain with sitting, playing sport or driving? Maybe you’ve had an MRI or X-ray that reports a labral tear, osteoarthritis or bursitis. Never fear, at Back to Bounce Sports Physiotherapy we have experienced physiotherapists who have completed extra training in sports, exercise and hip pathology diagnosis and rehabilitation. In this blog, we explore some common hip injuries and discuss treatment options. Today we will explore three common types of hip pain that we see at Back to Bounce Sports Physiotherapy; Osteoarthritis, Hip labral tear and Femeroacetabular Impingement.
Firstly, let’s have a quick look at the anatomy of the hip. The hip is a ball and socket joint which has many structures, most of which can become a source of pain or injury, depending on your age, mechanism of injury, sport played and genetic disposition. The hip joint involves the head of the femur (leg bone) and the socket of the pelvis called the acetabulum. Both ends of these bones are covered in smooth cartilage which helps smooth movement and gliding motion of the hip. Occasionally, when the smooth cartilage is affected, this can lead to stiffness, catching and occasionally a lack of range of motion. Between each bone is an extra piece of cartilage called a labrum. This can also become affected and even occasionally develop into a tear. Depending on a range of factors, occasionally symptoms of impingement at the front and back of the hip can develop. This can be an impingement of bone, soft tissue or labrum. Overlying this joint are a range of thick, soft tissues such as the hip capsule, fat pads, bursas, ligaments, muscles and tendons, all of which can become irritated leading to pain and can affect everyday activities. Let’s dive in to three common areas of hip pain.
Hip Osteoarthritis
Hip Osteoarthritis is commonly referred to as ‘wear and tear,’ age related, or degenerative joint disease. This terminology can often incite fear for people when they receive a diagnosis of Osteoarthritis. When people present with a diagnosis of Hip Osteoarthritis on an Xray, it doesn’t always mean they will have pain. With time, degenerative changes do take place within joints, particularly weight bearing joints such as the hip and knee. However, a diagnosis of Osteoarthritis does not mean that all hope is lost.
Osteoarthritis primarily affects the structural integrity of articular cartilage, the surrounding joint capsule, synovium, bone, ligaments and surrounding muscles. Osteoarthritis can result in a loss of mobility, and also can lead to a loss of independence and functional ability. Ther are a few risk factors linked to the development of Hip Osteoarthritis including age, gender, genetics and obesity to name a few.
Symptoms of Hip Osteoarthritis
Joint stiffness after resting for prolonged periods
Joint swelling/heat
Pain deep in the hip, groin, side or back of the hip and may refer down the leg
Walking is painful
Pain with sitting for long periods
Gradual loss of range of motion
Management of Hip Osteoarthritis
An important note to make is the high-quality research that indicates the benefits of exercise on pain reduction for hip osteoarthritis. Exercise such as strengthening, hydrotherapy and functional exercises are great exercises for managing pain and improving functional capacity. Activities that involve twisting at the hip such as golf or high impact such as jogging should be replaced with activities that exert less stress on the hip joint such as gentle yoga, cycling, or swimming.
Many people believe that joint replacement surgery is the only option for managing osteoarthritis. However, strong research suggests that there are many conservative treatment options that are effective for managing pain associated with osteoarthritis. These include being educated and understanding the nature of joint pain associated with osteoarthritis, exercise, physiotherapy, medication and in some instances, injection therapy. Check out our infographic below for more information on managing Hip Osteoarthritis.
Femoroacetabular Impingement
Femoroacetabular Impingement is a syndrome (FAIS) and to be diagnosed, the patient has to present with a combination of; presence of cam or pincer morphology on X-ray, symptoms of pain and clinical signs.
FAIS is common in athletes who play kicking sports such as AFL and football. Because femoroacetabular impingement pain can present as hip, back, buttock or thigh pain, it is important to get a thorough assessment to eliminate any other possible diagnosis. People with FAIS can also experience a clicking, catching or locking and will generally feel increased stiffness of the joint. Now just because you get a pinch in the hip every now and then certainly doesn’t mean that you have a significant injury or issue that needs specific rehab. As everyone is made differently, hip joint shape and your overall makeup play a large role in what feels comfortable when squatting and what will feel a bit unpleasant.
Symptoms of Femoroacetabular Impingement
Pinching at the front of the hip with sitting or getting in and out of the care
Pain with crossing the legs
Pain usually at the front of the hip but can also be in the back, buttock and thigh
Occasional clicking, locking and stiffness of the joint
In many cases, FAIS can be managed well with specific guidance from your physiotherapist regarding exercise, sitting positions, mobility work, work postures and pain-relieving strategies. Physiotherapy can help relieve pain with dry needling, manual therapy, exercises and soft tissue release.
Labral Tears
A labral tear in the hip is an injury to the cartilaginous soft tissue that sits between the femur (leg bone) and acetabulum (socket of the pelvis). The labrum is a ring of cartilage that provides suction to provide stability to the hip joint, absorbing and distributing pressure with lower lib movement. When injured, the labrum may become torn, fray around the edges, and in some cases can even detach or pull away from the acetabular socket.
The important thing to take note of is that hip labral tears are present in people with and without pain. One review reported that on average, 62% of those with hip pain have labral tears present on imaging, while 54% of those without hip pain also had hip labral tears. What this means is that it is possible to have a hip labral tear but no hip pain. It also means that just because a hip labral tear is reported on scans, it does not necessarily mean it is the source of pain. Because labral tears often are only diagnosed with a specialized diagnostic scan called an MRA, labral tears frequently go undiagnosed for an extended period of time. Studies have shown that often there is on average greater than two years before diagnosis.
Symptoms of Labral Tear
Pain at the front of the hip and into the groin
Clicking or catching sensation
Slow progression of pain OR a sudden sharp pain following a twisting movement, fall, motor vehicle accident, sudden impact playing sport
Pain with activities such as walking, pivoting/twisting and running
Walking on an incline
Deep groin pain
Symptomatic labral tears can be treated with or without surgery. If surgery is needed, it can be done with a minimally invasive approach. It is imperative to gain a thorough assessment by an experienced health practitioner in order to get a clear treatment plan. Commonly we see many patients do extremely well with conservative management with a consistent strength and mobility program.
Help for your Hip Pain
Are you or someone you know suffering from ongoing hip pain that’s stopping you from doing the things you love?
With experience in the management of hip pain associated with osteoarthritis, impingement, tendinopathy, bursitis and hypermobility, at Back to Bounce Sports Physiotherapy we thoroughly assess and guide you through your rehabilitation plan to help you get back to doing the activities you love.
At Back to Bounce Sports Physiotherapy, we treat a range of hip conditions such as;
Gluteal tendinopathy
Trochanteric bursitis
Labral tear
Femoroacetabular impingement
Adolescent hip injuries
Prehab (pre surgery) and Rehab (post-surgery) for total hip replacement surgery
Osteoarthritis
Piriformis Syndrome
To check out our blogs about hip pain, head to:
https://www.backtobounce.com.au/blog/management-of-osteoarthritis
https://www.backtobounce.com.au/blog/glutealtendon
References
Lespasio MJ, Sultan AA, Piuzzi NS, Khlopas A, Husni ME, Muschler GF, Mont MA. Hip Osteoarthritis: A Primer. Perm J. 2018;22:17-084. doi: 10.7812/TPP/17-084. PMID: 29309269; PMCID: PMC5760056.
Heerey, J., Kemp, J., Mosler, A., Jones, D., Pizzari, T., Souza, R. and Crossley, K., 2018. What is the prevalence of imaging-defined intra-articular hip pathologies in people with and without pain? A systematic review and meta-analysis. British Journal of Sports Medicine, 52(9), pp.581-593.
Griffin DR, Dickenson EJ, O'Donnell J, et al The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement British Journal of Sports Medicine 2016;50:1169-1176.
Groh MM, Herrera J. A comprehensive review of hip labral tears. Curr Rev Musculoskelet Med. 2009 Jun;2(2):105-17. doi: 10.1007/s12178-009-9052-9. Epub 2009 Apr 7. PMID: 19468871; PMCID: PMC2697339.
